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Ultrasound definition of enthesitis in spondyloarthritis and psoriatic arthritis: arrival or starting point?
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  • Published on:
    A closer look at the enthesis using ultrasound
    • Sibel Z. Aydin, Rheumatologist University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, ON, Canada
    • Other Contributors:
      • Lihi Eder, Rheumatologist
      • Gurjit S Kaeley, Rheumatologist

    We read the editorial by Filippucci et al., entitled "Ultrasound definition of enthesitis in spondyloarthritis and psoriatic arthritis: arrival or starting point?" with great interest. The authors eloquently discuss the challenges with the existing scoring methods and propose solutions (1). We would like to raise additional points that we believe are necessary to improve the assessment of enthesitis using ultrasound.

    Before the introduction of ultrasound to the field, enthesitis was determined as present or absent, based on the physical exam. Therefore, only prevalence could be compared between patient groups. Ultrasound allows precise phenotyping of the entheseal changes. The ability to accurately characterize anatomical changes within the entheseal soft tissue and on the surface of the bone, detect abnormal vascularisation and further categorize the two opposite bony changes (erosion vs new bone formation) brought a different perspective on the understanding of enthesitis. Despite some similarities between psoriatic arthritis (PsA) and other spondyloarthritis (SpA) subtypes, clear distinctions also exist (2). From the enthesitis perspective, patients with PsA have larger enthesophytes (bony spurs) at the entheseal insertions than ankylosing spondylitis (AS), despite similar levels of sonographic inflammation (3). Supporting that observation, psoriasis is shown to be an independent risk factor for enthesophytes with Axial SpA (4). Similar findings have lo...

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    Conflict of Interest:
    None declared.